Poorly performing GPs face exile under NHS reforms

Under-performing GPs could be effectively driven out of practice under reforms
to the NHS, according to a legal expert.

Doctors who prescribe too many drugs or needlessly send patients to hospital could be pushed out of new organisations by their peers, in an attempt to keep their costs down and receive higher bonuses.

But because anyone who wants to practice on the NHS under the new regime must belong to a local consortium, those who are cast out could be left be unable to work.

Since those remaining would take on their former patients, the little-noticed consequence of the Government’s controversial health reforms may be seen as a good thing by driving out costly and poorly performing GPs.

Forcing doctors to join consortia, which will replace Primary Care Trusts in buying £60billion of treatment a year from NHS hospitals or private providers, is a key element of the Health and Social Care Bill, which is currently on “pause” over fears it will lead to the backdoor privatisation of the health service.

The prospect was raised by Christian Dingwall, a partner at the law firm Hempsons, who told a Westminster Health Forum conference recently that it has been suggested that up to a fifth of GPs under-performing because they “over prescribe or they over refer”.

“In other words, they seem to be costing the NHS an undue amount of money.”

He said it is “unlikely” that better-performing GPs will want to share their consortium with underperforming GPs and might look to exclude them. This is because they will be eligible for extra money if a new body that oversees them, the NHS Commissioning Board, thinks it has done well. A proportion of practice income will also come in the form of a “quality premium”.

Mr Dingwall went on: “Now this is critically important for a GP because if you are not going to be a member of a consortium you cannot hold a primary care contract.

“So, it seems that the GP consortium is going to be absolutely critical as to who will be able to hold a primary care contract and can be a player at all within primary care, let alone the wider health care market.”

Mr Hempson added to The Daily Telegraph that consortia would not be able to expel doctors arbitrarily, or simply in order to acquire their patient lists or profits, as any decisions to change their membership would have to be approved by the NHS Commissioning Board.

Another health expert said: “I think peer group pressure on GPs is going to be a powerful lever. Whether this gets to the stage of GPs being driven out of consortia I don’t know but, certainly from the work I have been doing with some consortia, it is clear that they are going to be very hot on what they consider to be bad practice.”

A spokesman for the Department of Health said: "We have set out plans that will make services more responsive to patients and consistently drive up quality. However we want to get this right. That is why we are pausing, listening and reflecting so we can improve our NHS for everyone."